The K23 Candidate (Dr. Falciglia) is an Assistant Professor of Medicine in the Division of Endocrinology at the University of Cincinnati College of Medicine. This award will provide the candidate with scholarly training, mentorship, and support necessary to develop into an independent clinical researcher. Recent studies, including work by Dr. Falciglia, have shown that hyperglycemia in critically ill patients without known diabetes is both common and associated with a high risk of mortality. However, the etiology of inpatient hyperglycemia in nondiabetic patients, and the relation to adverse outcomes are not understood. The candidate will address this gap in knowledge by determining the contribution of underlying diabetes or metabolic abnormalities to hyperglycemia in hospitalized patients. Her long-term objectives are 1) to identify the causes and consequences of hospital-related hyperglycemia and ultimately develop strategies for early intervention to reduce mortality in hospitalized patients, and 2) to become an independent clinical investigator leading a diabetes research program that is competitive for external funding. To achieve these career objectives, the candidate proposes a five-year training program with faculty members having expertise in endocrinology and clinical outcomes research. Her primary sponsor is a highly accomplished diabetes researcher whose work has focused on beta-cell function in adults with type-2 diabetes. Her co-sponsor is a critical care specialist and leader in outcomes research related to intensive care unit patients. The candidate's proposed research involves two complementary projects: 1) Specific Aim 1 will determine whether hyperglycemia during critical illness predicts future diabetes and cardiovascular disease;2) Specific Aim 2 will characterize glucose tolerance, insulin secretion, insulin sensitivity and cardiovascular risk factors in patients with and without illness-related hyperglycemia following recovery and discharge from the hospital. Completion of these projects will determine the relative roles of illness-related stress and inherent metabolic capabilities of affected patients to cause inpatient hyperglycemia, and the role of underlying cardiovascular risk to cause mortality in these patients. Results from this study will provide new information that will advance the treatment of hospitalized patients, give insight into the natural history of diabetes and identification of individuals at high risk for future diabetes and cardiovascular disease.